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Nebraska rates for HCPCS Q4117

HYALOMATRIX, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.95 / $22.95 / $28.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $22.95 / $24.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.27 / $19.14 / $19.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.18 / $19.14 / $19.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.47 / $24.39 / $43.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $37.86 / $43.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $29.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.47 / $22.83 / $43.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.47 / $26.08 / $43.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.26 / $28.69 / $31.56